Dancing with Depression (3)

Introduction:

This is the third in a series of articles to help bring depression “out of the closet,” to demystify it, remove the sense of shame or defect for having it and provide some accurate information about what depression really is and ways to learn to “dance” with it rather than fight it. In the first two articles we looked at the experience of depression, how it feels, the effect it can have on our thinking and perceiving process and what some of the causes of depression are. In this article we will examine how trauma can result in severe and persistent depression that sometimes leads to self-harm and suicidal thoughts and impulses.

Trauma and Depression

As mentioned in the last article there are many types and multiple possible causes of depression. Trauma particularly what is known as complex trauma is often associated with severe and persistent depression. People who have endured personal violation such as rape, physical, sexual and/or emotional abuse and neglect, particularly repeated episodes as children often develop complex trauma and are more likely to suffer from severe and persistent depression. This type of depression also seems more resistant to treatment and is more likely to be accompanied by suicidal thoughts, impulses and actions. This is the type of depression I’ve become very familiar with.

Repeated violations to physical and emotional safety and integrity especially at an early age is highly disruptive to developing a coherent sense of self and stable self-esteem. Trauma is a highly energetic, disruptive intrusion into the developing self that often prevents the consolidation of a whole and integrated sense of integrity and identity. Rather, a person may experience themselves as “weak,” “fragile,” or “incomplete.” They often experience intense instability, even volatility in their emotions and can repeatedly find themselves in chaotic relationships. There may also be difficulties controlling impulses and are prone to intense feelings of self-loathing and at times self-harming behaviors.

The depression experienced by people who have experienced complex trauma is often severe and persistent. The depth of pain and anguish experienced is usually difficult for others to understand. There is often the sense of a “bottomless pit of pain,” that threatens to swallow the person whole or to fragment their fragile sense of self into pieces. There is an authentic sense of victimization and helplessness that cannot be abated by being encouraged to “snap out of it.” The resulting sense of inadequacy, self-blame and hopelessness places these individuals at a much higher risk for self-harm and suicide.

Self-harm and Suicide Risk

Self-harming behavior is not the same thing as a suicide attempt although it places the individual who repeatedly harms themselves at a higher risk for injury and/or death. Many people inflict harm on themselves in a myriad of ways; from substance abuse to getting repeatedly involved in hurtful relationships to cutting, burning even swallowing razor blades. As a mental health examiner I’ve personally worked with many individuals who repeatedly harm themselves for a variety of reasons other than to die by suicide including; punishing, distracting, stimulating, releasing, even arousal. For many people who have chronically dissociated or disconnected from their physical/emotional sense of self as a protection from the pain of past traumatic injuries, the stimulation of self-harm is sometimes all that can be felt; and to feel pain is better than to feel nothing.

Suicide risk is measured more in relation to the frequency, intensity and duration of suicidal thoughts, intentions and plans in combination with known risk factors. There is often a progression of depression leading to suicide that is sometimes not apparent to others because it may be concealed, particularly in the final phase. People who are at higher risk for suicide often express suicidal thoughts and intentions that are frequent sometimes obsessive, very intense that they have endured “past their limit.” They have created a specific plan that they have prepared and rehearsed. In the last phase of their depression called the “6 day amazing reversal” they have made their mind up to suicide and may appear to have “improved.”

Risk factors are known identifiers associated with people who have taken their lives by suicide including: Currently suffering from Major Depressive Disorder or Bipolar Affective Disorder, alcohol and/or drug abuse and dependence and Schizophrenia, Others include past trauma and/or PTSD, eating disorders, Borderline and Antisocial personality disorders. The one risk factor that stands out far more than all of the others is previous attempts.

Previous suicide attempts – not gestures, particularly those that would have resulted in death if not discovered and stopped is the single most powerful predictor because a person who has actually attempted suicide and did not expect to be rescued crossed a line. Its a line I remember crossing many years ago. The experience is still fresh. It is the experience that something inside of me broke. The depression was so severe and unbearable, something literally “snapped.” I can still remember the sensation. At the point of the snap, something within the foundation of my sense of self gave way. It was both defeat and relief. The fight was over. I remember thinking “clearly” for the first time in months: “of course, suicide IS the solution – how could I have missed it before?”

At that time I was living with a roommate, a childhood friend I knew very well. I knew when he left for work, his typical pattern in the morning and when he got back in the evening. I was working shifts in the emergency room and had a great deal of flexibility in my schedule. I planned it all out calmly and carefully. I waited until Monday morning – a morning I had off and I knew he had to drive a long distance to get to his work. After he pulled his car out of the garage and was gone for thirty minutes I pulled mine in. I taped the door shut with plastic. It was a small garage and the fumes would fill up fast. I knew the fumes would irritate my eyes and make me choke so I stole medication I took from a patient I saw in the emergency room who attempted suicide by overdose. I estimated there weren’t enough left to kill me, but would certainly put me in a deep sleep. I swallowed the medication, turned on my car and went to sleep.

Next article will be on "dancing" with depression.